X-ray diagnostics - Mammography

What is mammography, how useful is it, how harmful is it, and what is its reliability?

Mammography is a non-invasive diagnostic method that produces an image using X-rays on a device called a mammography unit.

Mammography is the most appropriate diagnostic method for detecting malignant breast tumours of minimal dimensions, even those that cannot be palpated. If the tumour is detected at this stage of the disease, when the dimension is smaller than 1cm, when it cannot be palpated, before it has passed into an aggressive form and given metastases, the prognosis is good and complete cure can be achieved.

The radiologist interprets the images and provides a written report with the mandatory BI RADS classification (each finding is characterised by letters and numbers BI RADS 0-6 with text explaining it).

Changes visible on mammography:

1. Tumour shadows;

2. Zones of asymmetry and disturbances of breast structure which may indicate a tumour that is invading surrounding tissue;

3. Calcifications that can be larger - macrocalcifications and smaller - microcalcifications. After examination of shape, size and number of calcium deposits visible on mammogram, grouping is performed into benign, probably benign and suspicious (suspect) types.

Mammography is the "gold standard" for detecting breast cancer.

Every woman over the age of 40 should undergo mammography.

Radiation dose the radiation dose that a patient receives during mammography is small, i.e., equal to the amount of cosmic radiation that the organism receives during 7 weeks or the amount of radiation absorbed during one transoceanic flight, so the fear of radiation is unjustified.

Newer generation devices automatically adjust the radiation dose to a minimum for each patient. The images obtained on such devices (using special mammographic projections such as imaging at a different angle, with compression, with magnification) are of high resolution, which enables the detection of minimal changes in the breast.

The accuracy of the mammographic finding depends on several factors:

1. technical characteristics of the apparatus

2. knowledge and experience of radiologists

3. age and breast tissue density (breasts of young women contain more milk glands and ligaments that can mask cancer shadows, while with age the amount of milk glands decreases and fatty tissue increases, which facilitates interpretation of findings).

In approximately 10% of cases, breast cancer may not be visible on a mammogram. As supplementary diagnostic methods breast ultrasound is used, and in some cases magnetic resonance imaging and breast-tissue biopsy are also used.

Preparation and method of performing mammography:

- Before performing mammography, do not apply creams, lotions, or deodorants to the breast skin. These substances can be seen on the image and may mimic pathological changes, which complicates the interpretation and analysis of the findings.

- Before starting the X-ray, inform the technician about the presence of implants, any complaints you may have, and pregnancy.

- Clothing is removed to the waist, jewellery is removed, and a standing position is assumed

- The radiographer places the breast between two plates that move and apply pressure to the breast for a duration of 5 to 10 seconds, which the patient feels as minor pain or discomfort. Greater pressure on the breast reduces the radiation dose and yields a higher quality image. Mammographically, each breast is examined in two projections (CC and MLO).

- The entire recording takes several minutes, after which the patient is ready for daily activities.

Mammography can be performed at any time during the menstrual cycle, but because breasts may be sensitive during the premenstrual phase, it is recommended between days 5 and 12 of the menstrual cycle (counting from the first day of menstrual bleeding).